Objective: Use of fetal tissue for cytogenetic analysis in cases of second- and third-trimester fetal demise frequently results in unacceptably high failure rates. We reviewed our ongoing use of amniocentesis prior to uterine evacuation to determine if this provided a better source of cells for cytogenetic analysis. Methods: We compared cytogenetic results using fetal tissues obtained following uterine evacuation to our ongoing use of amniotic fluid cell obtained by transabdominal amniocentesis prior to uterine evacuation from 2003 to 2008. Results: In 49 of the 63 cases evaluated by fetal tissue biopsies performed after uterine evacuation, a karyotypic analysis was obtained (77.8%). Among the 38 cases evaluated by amniocentesis, an amniotic fluid sample and fetal cytogenetic results were obtained in all 38 (100%) cases. Conclusion: Our findings indicate that amniocentesis is a more reliable source of cytogenetic information than fetal tissue in cases of second- and third-trimester fetal demise.

The purpose of this study was to evaluate the outcomes of the social determinants component of a multiple determinants model of pre- and inter-conception care. Health department vital statistics and infectious disease data on birth and factors influencing birth outcomes were analyzed for participants in a program designed to mitigate the effects of social class and stress in contrast to a matched comparison group and other relevant populations. The program showed promising results related to reducing infant mortality and reducing other high-risk factors for poor birth outcomes, including low birth weight and sexually transmitted disease. Social determinant interventions, designed to mitigate the impact of social class and stress, should be considered with efforts to reduce infant mortality, particularly the disparities associated with infant mortality. Additional research should be conducted to refine replicable social determinant focused interventions and confirm and generalize these results.

AIM: To determine the incidence of nephrogenic systemic fibrosis (NSF) in stage 3 chronic kidney disease patients following intravenous exposure to gadobenate dimeglumine. MATERIALS AND METHODS: A prospective study was performed on 168 consecutive patients at a single institution with stage 3 chronic kidney disease who underwent clinically-indicated contrast-enhanced magnetic resonance imaging (MRI) examinations with gadobenate dimeglumine from January 2007 to March 2008. All patients were contacted by phone by investigators 3 months after MRI to verify the presence or absence of NSF signs or symptoms. If signs or symptoms suggestive of NSF developed, dermatologic referral was made and confirmatory skin biopsy performed if indicated. RESULTS: One hundred and eighty contrast-enhanced MRI examinations with gadobenate dimeglumine were performed on the 168 patients. Twenty patients were lost to follow-up, but 160 incidents of contrast medium exposure were followed up for 3-months and 105 incidents were followed up for 6 months. The mean contrast medium dose per weight was 0.093 mmol/kg (range 0.042-0.153 mmol/kg). The mean estimated creatinine clearance was 50.4 ml/min/1.73 m(2)(range from 30-59 ml/min/1.73 m(2)). Ten patients developed skin rashes during the 3-month follow-up period, but none were confirmed to represent NSF (0% prevalence rate). No other signs or symptoms of NSF were reported. CONCLUSION: Based on this limited study, NSF does not appear to occur in patients with stage 3 chronic kidney disease exposed to intravenous gadobenate dimeglumine for MRI at standard dosing of approximately 0.1 mmol/kg.

The classic definition of congenital tracheal stenosis includes the presence of complete tracheal rings with absence of the membranous portion of the trachea. The morphologic type, based on Cantrell's classification, dictates the surgical management. In this report, we describe the presentation and surgical management of a novel type of distal congenital tracheal stenosis referred to as "corkscrew" trachea.

The purpose of this secondary analysis was to compare gender differences in retrospective reports of acute myocardial infarction (AMI) symptoms resulting from two different assessment methods: the open-ended inquiry and the combined assessment approach. Women reported more atypical symptoms in their responses to the open-ended inquiry and a greater number of typical, atypical, and total symptoms in the combined assessment approach in which the open-ended inquiry was followed by a series of closed-ended questions. Women reported more jaw/neck pain, dyspnea, and palpitations in response to the open-ended inquiry. In the combined assessment, men reported more chest pain/discomfort than women, whereas women were more likely to report jaw/neck pain, dyspnea, back pain, fatigue, paroxysmal nocturnal dyspnea, and palpitations. The data suggest that careful attention to the type of questions used to assess AMI symptoms could lead to more definitive conclusions regarding gender differences in AMI symptoms.

ABSTRACT: BACKGROUND: New rapid high-throughput sequencing technologies have sparked the creation of a new class of assembler. Since all high-throughput sequencing platforms incorporate errors in their output, short-read assemblers must be designed to account for this error while utilizing all available data. RESULTS: We have designed and implemented an assembler, Quality-value guided Short Read Assembler, created to take advantage of quality-value scores as a further method of dealing with error. Compared to previous published algorithms, our assembler shows significant improvements not only in speed but also in output quality. CONCLUSIONS: QSRA generally produced the highest genomic coverage, while being faster than VCAKE and implementing the use of q-values. QSRA is extremely competitive in its longest contig and N50/N80 contig length, producing results of similar quality to those of EDENA and VELVET. QSRA provides a step closer to the goal of de novo assembly of complex genomes, improving upon the original VCAKE algorithm by not only drastically reducing runtimes but also increasing the viability of the assembly algorithm by addition of further error handling capabilities.

We evaluated our experience with the surgical management of aortic coarctation (ACo) in adults with concurrent cardiac and aortic disease approached via median sternotomy. Eight patients were presented using a variety of repair techniques including end-to-end anastomosis, transpericardial ascending aorta to descending aorta bypass, and stage 1 elephant trunk insertion. All patients were male and symptomatic at presentation. The average age was 41 years (range, 27-67 years). The systolic blood pressure decreased by a mean of 49 mmHg in the patients presenting with hypertension. The postoperative New York Heart Association functional class was I or II in all patients. Mean length of stay was 7.7 days. There were no perioperative complications, and overall survival was 100%. Operative repair of complex ACo can be safely accomplished through the mediastinum in patients in whom a conventional left thoracotomy may not be the preferred approach.

OBJECTIVES: Right ventricular sinus myectomy has been proposed for pulmonary atresia with intact ventricular septum for morphology falling within the uncertain area for eventual biventricular repair. Our objective was to evaluate right ventricular sinus myectomy by characterizing the morphologic spectrum of these patients, determining whether biventricular repair was achieved, ascertaining growth of right-sided structures, and assessing survival. METHODS: We evaluated medical records, all imaging studies, and follow-up data (complete in all but 1 patient) from 43 patients with pulmonary atresia with intact ventricular septum treated from October 1993 to July 2005, 16 of whom underwent right ventricular sinus myectomy. Serial echocardiographic measurements of right-sided cardiac structures were converted to Z values to estimate their growth relative to somatic growth. RESULTS: Patients undergoing right ventricular sinus myectomy had mild-to-moderate right ventricular size diminution (grade -1.2 +/- 3.2) and a tricuspid valve Z value of -4.9 +/- 1.9. Thirteen (87%) of the 16 patients achieved biventricular repair. After right ventricular sinus myectomy, mean right ventricular cavity size grade increased to 1.4 +/- 0.66, but the tricuspid valve Z value did not change appreciably over time. Five-year survival after sinus myectomy was 85%; late deaths were in patients with the smallest tricuspid valves at presentation (Z value <-7). CONCLUSIONS: Right ventricular sinus myectomy in the uncertain area for biventricular repair of pulmonary atresia with intact ventricular septum leads to immediate increase in right ventricular volume. It, in combination with establishing right ventricle-pulmonary trunk continuity, allowed early biventricular repair in 87% of patients. However, tricuspid valve growth in relation to somatic growth was minimal. Thus, small tricuspid valve size might limit the long-term success of biventricular repair achieved by means of right ventricular sinus myectomy.